Department of Neurology, University of Ottawa, Ottawa, Canada.
Can J Neurol Sci. 2010 Sep;37(5):588-94. doi: 10.1017/s031716710001074x.
Patients with chronic migraine and medication overuse are significant consumers of health care resources.
To determine whether botulinum toxin type A prophylaxis reduces the cost of acute migraine medications in patients with chronic migraine and triptan overuse.
In this multicenter, open-label study, patients with chronic migraine (≥ 15 headache days/month) who were triptan overusers (triptan intake ≥ 10 days/month for ≥ 3 months) received botulinum toxin type A (95-130 U) at baseline and month three. Headache (HA) frequency and medication use were assessed with patient diaries, and headache-related disability by means of the MIDAS and Headache Impact Test-6 questionnaires.
Of 53 patients enrolled (mean age ± standard deviation, 46.5 years ± 8.4; 47 [88.7%] females), 48 (90.6%) completed the study at month six. Based on headache diaries, significant (P ≤ 0.0002) decreases from baseline were observed for days per month with headache/migraine, days with any acute headache medication use, days with triptan use, and triptan doses taken per month. A significant (P < 0.0001) increase from baseline in headache-free days per month was also observed. Prescription medication costs for acute headache medications decreased significantly, including significant reductions in triptan costs (mean reduction of -C$106.32 ± 122.87/month during botulinum toxin type A prophylaxis; P < 0.0001). At baseline, 78% of patients had severe disability (MIDAS score) and 86.8% had severe impact due to headache (HIT-6 scores); at month six, this decreased to 60% and 68%, respectively.
Botulinum toxin type A prophylactic therapy markedly decreased costs related to acute headache medication use in patients with chronic migraine and triptan overuse.
慢性偏头痛和药物过度使用者是大量消耗医疗资源的患者。
确定肉毒毒素 A 预防是否能降低慢性偏头痛和曲坦类药物过度使用者的急性偏头痛药物的成本。
在这项多中心、开放标签研究中，慢性偏头痛（每月≥ 15 天头痛）和曲坦类药物过度使用者（每月曲坦类药物摄入≥ 10 天，持续≥ 3 个月）接受肉毒毒素 A（95-130U）治疗。通过患者日记评估头痛（HA）频率和药物使用情况，通过偏头痛残疾程度量表（MIDAS）和头痛影响测试-6 问卷评估头痛相关残疾。
53 名入组患者（平均年龄±标准差，46.5 岁±8.4；47[88.7%]名女性）中，48 名（90.6%）在第 6 个月完成了研究。根据头痛日记，从基线开始，每月头痛/偏头痛天数、任何急性头痛药物使用天数、曲坦类药物使用天数和每月曲坦类药物剂量均有显著（P≤0.0002）减少。每月无头痛天数也显著增加（P<0.0001）。急性头痛药物的处方药费用显著降低，包括曲坦类药物费用的显著减少（肉毒毒素 A 预防期间每月减少-C$106.32±122.87；P<0.0001）。基线时，78%的患者有严重残疾（MIDAS 评分），86.8%的患者有严重头痛影响（HIT-6 评分）；第 6 个月时，分别降至 60%和 68%。
肉毒毒素 A 预防性治疗显著降低了慢性偏头痛和曲坦类药物过度使用者急性头痛药物使用相关的成本。
